Pediatrics: Evaluation and management of gender identity disorder—an American tale

Abstract

The Gender Management Service (GeMS) Clinic opened in 2007 as an extension to services already offered at Children’s Hospital Boston. It is the first focused, multidisciplinary group in North America offering medical treatment to gender-dysphoric children. Using methods largely developed in The Netherlands (the so-called Dutch Protocol), the clinicians and researchers recently reported their experiences in Pediatrics, advocating for the early evaluation of these children and for consideration of their stage of puberty rather than their age. Guidelines from the Endocrine Society on the treatment of transsexual patients state that prepubertal children should not undergo gender-changing therapy. Instead, young patients (Tanner stage 2 or 3) should undergo puberty blockade with gonadotrophin-releasing hormone analogues (GnRHa). The reasoning for this guideline is the high rate of remission of gender identity disorder (GID) after the onset of puberty. “Adolescents with an unstable, and possibly unsettled, gender role and identity can, and occasionally do, change their minds, sometimes more than once,” explains expert endocrinologist David Handelsman of the ANZAC Research Institute at The University of Sydney, Australia, who is not involved with the GeMS clinic. “Puberty suppression with GnRHa is the best way to support adolescent patients in their desires to interrupt the unwanted features of adult sex as well as deferring definitive treatment, including surgery, until the patient has attained greater personal maturity.” The team at the GeMS Clinic, led by Norman Spack and David Diamond, used the time gained from GnRHa treatment for counseling and psychotherapy, and to give their young patients the opportunity to explore being the new gender before deciding to irreversibly change his or her body. The extra time also gives patients and their families the opportunity to PEDIATRICS